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Date of Award


Degree Type

Restricted Evidence-Based Project Report

Degree Name

Doctor of Nursing Practice (DNP)



First Advisor

Nola A. Schmidt


Chronic insomnia is a significant health condition affecting approximately 10% of the population. Cognitive behavioral therapy for insomnia (CBT-I) is an evidence-based practice (EBP) recommended in clinical guidelines for insomnia as first line treatment for adults. Despite this evidence, CBT-I is widely underused and its availability is sparse due in part to the deficit of practitioners prepared to deliver CBT-I. The purpose of this EBP project, using the Iowa model for evidence-based practice, was to implement and evaluate a nurse-led group CBT-I program. Fourteen adults with insomnia attended 5-session CBT-I programs led by a psychiatric/mental health clinical nurse specialist. Sleep diaries and the Insomnia Severity Index (ISI) were used to obtain outcome measures of sleep quantity and quality before, during, and after the program. Paired t tests showed statistically significant improvement in wake after sleep onset, ISI scores, and medication usage post-intervention. Repeated measures ANOVAs revealed that a statistically significant change in ISI scores occurred by Session 3. Statistically significant reduction in medication usage occurred between Session 3, when the medication withdrawal process began, and Session 5. A patient satisfaction survey revealed high satisfaction with CBT-I. Patients commented most frequently about liking the instructor, educational information, and group format. Dorothea Orem’s (2001) self-care deficit theory of nursing provides a framework for which to appreciate nursing’s role in behavioral sleep medicine. CBT-I is a supportive-educative intervention that fosters self-care agency and, ultimately, effective self-care for the health problem of insomnia. Training opportunities are needed to increase the supply of CBT-I providers. Employing psychiatric nurses, who have the skill set needed to provide effective CBT-I, in sleep centers is one way to increase the availability of CBT-I to the millions of people who suffer with insomnia.


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